Almost all American adults over the age of 18 have drank alcohol at some point. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates close to 87 percent of the adult population has had at least one drink in their lifetime. Unlike many other addictive substances, alcohol is legal to those over age 21 and readily available.

Many people drink alcohol on a regular basis without any issues. In fact, Mayo Clinic publishes that drinking in moderation (no more than one drink a day for a woman and two for a man) may even have some health benefits. Patterns of binge or heavy drinking, (drinking more than four drinks for a woman or five for a man in a span of a few hours, or more than seven drinks a week for a woman and 14 per week for a man) can contribute to a problem with alcohol, according to NIAAA. Stats on alcohol abuse and its effects include:

An estimated 16.6 million American adults in 2013 had an alcohol use disorder (AUD), NIAAA

As someone drinks, levels of dopamine are elevated in the brain, resulting in a flood of pleasant feelings. Alcohol can elevate mood, increase self-confidence, and lower inhibitions. As alcohol leaves the bloodstream, these feelings and dopamine dissipate.

Repetitive alteration of the dopamine levels in the brain can cause it to expect the presence of alcohol and therefore discontinue its production at previous levels without the substance.

The more a person drinks, the more tolerant to alcohol the body becomes and the more dependent the brain may be on its interference. When alcohol’s effects wear off, someone who is dependent on it may suffer from withdrawal symptoms that can range from mild to life-threatening.

Alcohol Withdrawal Side Effects

Alcohol withdrawal is likely to start between six hours and a day after the last drink, as reported in American Family Physician. Withdrawal can be broken down into three stages of severity:

Alcohol withdrawal is highly individual, and it is influenced by several factors, such as length of time drinking, the amount consumed each time, medical history, presence of co-occurring mental health disorder, family history of addiction, childhood trauma, and stress levels. The use of other drugs in conjunction with alcohol can also influence withdrawal and increase the potential dangers and side effects. The more dependent on alcohol a person is, the more likely the person is to experience more severe withdrawal symptoms. Each person may not go through every stage of withdrawal, therefore.

The most serious form of alcohol withdrawal is delirium tremens (DTs), which occurs in 3-5 percent of individuals in alcohol withdrawal, according to the New England Journal of Medicine (NEJM), and it can be fatal without treatment.

DTs may not start for a day or two after alcohol leaves the bloodstream, and it can occur without warning. It is primarily for this reason that alcohol withdrawal should be closely supervised by a medical professional who can continually monitor vital symptoms and ensure the individual’s safety during detox.

Stopping drinking “cold turkey”is never recommended without medical supervision. Alcohol withdrawal can be fatal, as the brain and central nervous system experience a rebound after being suppressed by alcohol repetitively for an extended period of time. Sudden removal of the central nervous system depressant can be life-threatening.

Detox Timeline

There is no specific and concrete timeline for alcohol withdrawal; however, it is typically held that withdrawal will follow the following general timeline, as detailed by the National Library of Medicine (NLM):

Roughly 8 hours after first drink: The first stage withdrawal symptoms may begin.

After 24-72 hours: Symptoms generally peak in this time period, and stage 2 and 3 symptoms can rapidly manifest.

5-7 days later: Symptoms may start to taper off and decrease in intensity.

Beyond the first week: Some side effects, particularly the psychological ones, may continue for several weeks without treatment.

During detox, the first step is usually to monitor and control the physical symptoms and reach a stable point. This is often accomplished via medical detox, which may use medications to treat symptoms like nausea, dehydration, seizures, and insomnia. Benzodiazepines are commonly used during alcohol detox to reduce some of the potential over-activity the central nervous system may undergo as it attempts to restore its natural order. Blood pressure, heart rate, respiration, and body temperature should all be closely monitored in a medical detox center, and steps can be taken to ensure that they remain at safe levels.

At times, alcohol usage may be slowly reduced over a period of time through a detailed tapering schedule that should be set up and supervised by a medical professional. In this way, alcohol can be weaned out of the system in a controlled manner in order to avoid more dangerous withdrawal side effects.Someone dependent on alcohol may also suffer from malnutrition. Supplements and the implementation of a healthy diet and regular sleep schedule may improve withdrawal side effects and help the body heal faster.

Managing Symptoms in a Detox Center

After the physical symptoms have been controlled, mental health professionals can help reduce some of the more powerful emotional side effects of withdrawal.

Anxiety, depression, and potential suicidal ideations can be managed by medications coupled with therapy and counseling sessions. Preventing relapse is an important part of any alcohol detox center, and 12-step groups and individual therapy can offer continued support through detox and beyond.

Alcohol detox centers use three medications, which approved by the U.S. Food and Drug Administration (FDA), to help with alcohol-related cravings in the treatment of alcohol withdrawal and dependency: disulfiram, naltrexone, and acamprosate. These medications work to manage withdrawal symptoms and discourage individuals from drinking again. Naltrexone blocks opioid receptors in the brain, thereby reducing cravings and the potential rewards that may come from drinking, while acamprosate is believed to work on long-term withdrawal symptoms. Disulfiram can make people sick if they drink, thereby making drinking undesirable. A fourth medication, topiramate, also shows promise for the treatment of alcohol use disorders by also potentially interfering with the way alcohol “rewards” drinkers, as reported in the journal Addiction Science and Clinical Practice.

Alcohol withdrawal should not be attempted without the professional help of a detox center, as symptoms can pop up and magnify very quickly. Even after the physical effects of alcohol withdrawal are under control, protracted withdrawal, or the continuation of emotional symptoms and cravings, can continue without the right level of support and treatment.

A medical detox program can provide the most comprehensive and supportive environment during all stages of alcohol withdrawal and detox.